Provider Demographics
NPI:1023343993
Name:FILLINGAME, DAMECA LETRICE (OT)
Entity type:Individual
Prefix:
First Name:DAMECA
Middle Name:LETRICE
Last Name:FILLINGAME
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX R
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813-0496
Mailing Address - Country:US
Mailing Address - Phone:229-725-2147
Mailing Address - Fax:229-725-2199
Practice Address - Street 1:55 RE JENNINGS AVE SE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-8722
Practice Address - Country:US
Practice Address - Phone:229-725-4272
Practice Address - Fax:229-725-2199
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist